09 May 2016 Unlocking innovation 'key' to NHS research success


Dr Kunnathur Rajan led tests in the 1970s into the effects of asbestos on the lungs and smoking-related cancers, reports the BBC.

Swansea University's Medical School Dean Prof Keith Lloyd said the key is to "unlock the innovation" in the NHS.

The Welsh Government has said a "significant minority" of doctors do research and it hopes numbers increase.

Despite time and financial pressures, Dr Rajan said allowing consultants to conduct studies would save the NHS money in the long-run because of any subsequent breakthroughs.


He said: "Doctors can be trained in medicine but that doesn't mean they can do research. It took me seven years [to learn]."

Indian-born Dr Rajan studied at the Christian Medical College, Vellore, and worked at hospitals around England before deciding to broaden his research by doing a PhD at Cambridge University.

While there, he worked with Dame Honor Fell, who is credited with developing the organ culture method, growing living cells in the laboratory so they can be studied.

In 1970, Dr Rajan joined the pneumoconiosis research unit at Cardiff's Llandough Hospital, where he led research looking into the effects of asbestos on the lungs.

To illustrate this, he developed the organ culture method for adult pleura (lining of the lung) and grew a tumour.

The work was seen as a breakthrough and the results published in the Nature journal in 1972.

Other research at the unit included looking at the effects of smoking on human lungs and maintaining pancreas and human brain tissue using the organ culture method.

When this work ended, Dr Rajan took a position as a consultant physician in rheumatology in Rhondda Cynon Taff.

After a visit to the USA for a conference, he was convinced diagnostic equipment to check bone density could help rising cases of people suffering from osteoporosis.

With no funding available in the NHS, he approached local mayor Edie May Evans, who helped raise £60,000. The service is running at Pontypridd's Dewi Sant Hospital.

"I scanned 16,000 patients on the NHS with it and published nearly 100 papers - I found that if you can catch the signs of osteoporosis early and treat it, you can save a lot of money.

"Early intervention can prevent fracture - which also means the quality of life for the patient is better because if they break their hip and have a replacement, it is not the same as having their own."

Dr Rajan described himself as "an eternal student" and said all consultants should carry out research alongside clinical work.

A "significant minority" is currently involved, according to Dr Jon Bisson, director of the Welsh Government's Health and Care Research Wales.

While he believes skills and job pressures make it "unrealistic" that all could carry out regular research, he wants to ensure everyone has a chance.

"We should be playing to individual strengths - some are more interested in research, some have backgrounds that make it more likely for them," he said.

"As we move forward, some will be the key investigators."

Currently, some doctors have a half day a week for research in their contract, while others are able to discuss ring-fencing time with their managers or apply for funding.

Dr Bisson added: "I want to see pockets of excellence that exist grow throughout Wales."

One of these is emerging through a link-up between Swansea University Medical School and the Abertawe Bro Morgannwg (ABMU) and Hywel Dda health boards.

Under the banner of A Regional Collaboration for Health (ARCH), it aims to develop more opportunities for healthcare research work. This will not be the route for all consultants though, said Prof Keith Lloyd, dean of the medical school.

While he said an "understanding of how to appraise evidence and understand research" is a core skill for all doctors, not all will be involved on an ongoing basis.

Some will instead focus on things like teaching and management alongside their clinical work.

However, he believes ARCH has the potential to "unlock the innovation" in the NHS.

Professor Keith Lloyd, Dean of Swansea University’s Medical School and ARCH Programme Board member said: “There are many things a consultant can do in addition to clinical work, specifically research, learning and teaching, innovation and management. Each is equally important.  

“An understanding of how to appraise evidence and understand research is a core skill for all doctors. But not all doctors need to do research on an ongoing basis.

“In terms of conflicts of interest, there is always the need to be transparent, and that is what ethics committees and research governance are in place for.

“Research is funded through a number of routes, such as Health and Care Research Wales, which is part of Welsh Government and each health board has a budget for R&D. Many other bodies fund health and life sciences research for example the research councils  and charities such as the Wellcome, Cancer Research UK and the British Heart foundation for example.

“The ARCH partners are incredibly lucky to have ABMU and Hywel Dda R&D directors of the highest calibre - in Professor Steve Bain and Dr Keir Lewis.

“The ARCH Programme is investing in healthcare research and innovation and the translation and implementation of that work. As part of ARCH, the Medical School, through its research and innovation arm at the Institute of Life Science (ILS) is currently developing a strategy for Intellectual Property (IP) harmonisation and commercialisation.

“This strategy will help unlock the innovation within the NHS and also give NHS staff a framework to help bring their innovation to life and support them to deliver that innovation to deliver real benefits to patients.”

Dr Gareth Davies, from the ILS who chairs the ARCH Research, Enterprise and Innovation Collaborative Team added: “ARCH is working with Welsh Government to further strengthen the support available to our clinicians and other health professionals to undertake research and innovation work.

“This includes a number of exciting initiatives which build upon work at Swansea University Medical School’s ILS, with the aim of taking concepts through to clinical and commercial impact. This will deliver a significant expansion in technical development, clinical research and commercialisation capability allowing colleagues across the NHS to engage in research and innovation alongside patient care.

“We look forward to launching these plans soon, which will deliver benefit to patients and enterprise across South West Wales and beyond.”

Professor Steve Bain, Assistant Medical Director for Research and Development for ABMU, said: “Consultants have the choice to use one of their allocated Supporting Professional Activities (SPA) sessions on research.

“ Research and development (R&D) within the health boards have funding to support and build capacity through backfill sessions and the employment of research nurses to support consultants. There is also a dedicated R&D budget which is based on the amount of health board research portfolio activity and there is also re-investment from involvement in commercially sponsored clinical research which enables  our consultants to build the resources available to them.

“The Health Boards have partner Clinical Trials Unit which support design methodology and the development of research which also provides dedicated support through trials managers who help support consultants’ workload.

“Welsh Government also run an annual Clinical Fellowship which is made available for consultants to bid to undertake protected time for their research work.”

Hywel Dda Medical Director and ARCH Programme Board member Dr Phil Kloer added: “In Hywel Dda we are committed to increasing the number of consultants involved in academic research work.

 “Through Hywel Dda’s ARCH partnership with Swansea University and ABMU health board, we have shown our commitment to the importance of research  and recognise the importance of this in contributing to the pace of discovery, but also its advantages in raising standards. This work also creates excellent career opportunities within our region and helps support the recruitment of high quality clinical staff.”



Through the project, Dr Ernest Azzopardi is able to divide his time between ABMU's Welsh Centre for Burns and Plastic Surgery and Swansea University Medical School.

His research into burn and surgical infection won the Royal College of Surgeons' Hunterian Medal, given for work which leads to substantial change in patient treatment.

He thinks the "unique approach" taken by ARCH will lead to many other breakthroughs.

Dr Azzopardi said: “ARCH (A Regional Collaboration for Health) is a unique project. I am honoured to be part of such a transformative approach to solving healthcare challenges.

“By working so closely with the University, the two ARCH health boards are uniquely placed to make major breakthroughs in how we improve the care given to our patients.

“Infection is a major challenge for the NHS. I do believe that through this collaboration between health and science - it is a challenge we will win.

"Infection is a major challenge for the NHS. I do believe that through this collaboration between health and science, it is a challenge we will win."

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